ALL ABOUT THE CREDENTIALING COMMITTEE

Have you ever wondered what credentialing is all about, what the Credentialing Committee is, who the members are, and what the heck they do?

Credentialing is an integral part of the CIGNA Quality Improvement Program. Its purpose is to ensure that our network is composed of licensed providers in good standing. The Credentialing Committee exists to develop credentialing policy and ensure its consistent implementation.

The Committee meets once a month, and carefully investigates reviews and discusses each credentialing application. The Committee is responsible for rejecting applications from those practitioners or facilities who fail to meet credentialing criteria due to licensing board actions, liability suits, and/or legal issues. Investigation is performed by Credentialing Specialists who communicate with practitioners, state licensing boards and local court systems.

Each individual practitioner’s application is assigned to a Credentialing Committee member based on geographic location and license type. The committee members are responsible for in-depth review of all available documentation on the case and for presenting the case to the Committee with a recommendation. The Committee discusses each case as presented and a decision is made as to whether or not the provider is accepted into the network. Twice a year, in February and August, the Committee reviews all adverse events and complaints about providers as part of their quality monitoring responsibility. In an average month, the agenda packet that goes out to Committee members prior to the meeting exceeds 300 pages!

In 2007, CIGNA credentialed 4,701 new behavioral health practitioners and recredentialed another 13,715 practitioners. Of those, the Credentialing Committee reviewed the credentialing files of 195 practitioners. In addition, the committee reviewed the files of 33 practitioners whose licensing boards had taken action against them.

Membership of the Credentialing Committee consists of individuals who fill the following positions within CIGNA's behavioral health network:

2 co-chair people made up of:
1 Medical Director
1 Credentialing Department staff member

2 additional staff psychiatrists
6 staff clinicians, at least Master’s prepared

5 contracted practitoners made up of:
1 Physician
1 Advanced Practice Nurse Practitioner
2 Ph.D. Psychologists
1 Master’s level therapist

Annually, all Credentialing Committee members and staff are required to sign a Confidentiality Agreement.

If you have questions about credentialing, please contact Tracy Mizsak at Tracy.Mizsak@CIGNA.com.

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